EP0555293B1 - Wundverschluss - Google Patents

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Publication number
EP0555293B1
EP0555293B1 EP91918817A EP91918817A EP0555293B1 EP 0555293 B1 EP0555293 B1 EP 0555293B1 EP 91918817 A EP91918817 A EP 91918817A EP 91918817 A EP91918817 A EP 91918817A EP 0555293 B1 EP0555293 B1 EP 0555293B1
Authority
EP
European Patent Office
Prior art keywords
closure
tube
surgical closure
fascia
surgical
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP91918817A
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German (de)
English (en)
French (fr)
Other versions
EP0555293A1 (de
Inventor
Martin Neumann
Ferdinand Dr. Köckerling
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Individual
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Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of EP0555293A1 publication Critical patent/EP0555293A1/de
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Publication of EP0555293B1 publication Critical patent/EP0555293B1/de
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Expired - Lifetime legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3937—Visible markers

Definitions

  • the present invention relates to a wound closure according to the preamble of claim 1.
  • Such a wound closure is known for example from DE-PS 34 44 782.
  • This wound closure serves in particular as a temporary abdominal cavity closure, preferably in the postoperative treatment of peritonitis.
  • the abdominal cavity is subject to a physiological, directed fluid flow, which is drained mainly through small openings in the peritoneal underside of the diaphragm. In this way, the bacteria are supplied to the systemic defense via the lymph channels.
  • the absorption capacity of the intraperitoneal fluid is increased by the mobility of the diaphragm and the intraperitoneal pressure.
  • this outflow is blocked by the pathophysiological development of fibrin and bacteria and the circulation is hampered by fibrin-related adhesions.
  • the immune system is disrupted and there is an increase in the bacterial masses, their toxins and fibrin. If it is not possible to stop the progression of peritonitis in time, a pathophysiological cascade starts that is constantly increasing in dynamism and can no longer be stopped at a certain point.
  • a simple check of the success of peritonitis is possible by chamber counting the leukocytes in the rinsing liquid.
  • a phase-out assessment can be carried out simply by inspection (turbidity, fibrin or blood admixtures). Rinsing water samples for resistance determination of the bacteria can be taken at any time via the catheter, as can other substances. (ZB electrolytes, protein, heparin).
  • the disadvantage here is that the abdomen is no longer accessible and therefore there is no longer any direct visual control, which is important if the discharge changes pathologically or the clinical condition of the patient deteriorates. Sealing and source of infection of the drainage passage points, as well as blockage or relocation of the drainage are typical complications. If access to the abdomen is required again, a relaparotomy must be performed.
  • the object of the present invention is to improve a temporary intracorporeal wound closure of the type mentioned at the outset in such a way that a completely pressure-tight closure is obtained, but which can nevertheless be opened as often as desired at any time.
  • the advantages of the two strategies described above can be combined, so that new, expanded therapeutic options, for example in abdominal surgery, are available, the use of which is not only limited to the treatment of peritonitis, but also, for example, in the treatment of Pancreatitis appears promising.
  • a temporary occlusion of the abdominal cavity is in principle possible if postoperative complications are to be expected. It can also be used as a temporary closure of other body cavities. Thanks to integrated connections for drainage hoses at the same time, the advantages of a continuous closed irrigation system or peritoneal dialysis can be exploited.
  • a further improvement can be achieved by a special structure and by the shape of the edge structure, which enables a non-positive and tight connection between the base plate and the fascia.
  • a fibrin glue can also be used.
  • the wound closure according to the invention can be sewn into the fascia 1 , that is the tendon plate of the abdominal wall, on the underside of the abdominal wall 2 , for example as a temporary abdominal cavity closure.
  • the edge 3 of a single fixing element 15 which surrounds the wound on all sides, is always referred to below as base area 15a , with its opening 4 to be provided above the wound, on all sides under the fascia 1 , with reference to the abdominal incision length pushed and sewn to the fascia 1 according to a possible embodiment according to Figures 3 and 3a .
  • the opening 4 selected in accordance with the cutting length can adapt to the wound gaping depending on the tension of the abdominal wall. This is achieved especially when the opening 4 is designed as a cutout which extends far into the corners in the form of a lancet or approximately an ellipse or a wide gap with rounded end faces.
  • the base 15a consists of flexible material which can also be elastically stretchable. However, the elasticity should not be too great in order to be able to generate sufficient transverse tension in the direction of the contraction of the wound.
  • the opening 4 is surrounded by, for example, a tube-shaped or funnel-shaped tube 5 , which is arranged so as to protrude perpendicularly to the base 15a and is made of flexible material with possibly low elasticity.
  • the term tube is to be understood as a tubular structure of any cross-sectional shape, which extends from the opening 4 , ie away from the wound, and forms a liquid-tight sleeve over its entire length.
  • a cover flap 6 is provided which is folded over after the folding, for example after the folding and / or after the tube 5 is folded over the tube fold or over the tube roller 19 , and on the other side of the tube 5 with the base 15a can be fastened so that the rollover length is variable.
  • the material for the base surface 15a , for the tube 5 and also for the cover flap 6 is selected with regard to the elasticity so that a sudden intra-abdominal pressure increase, such as a coughing thrust, is at least partially absorbed can. In this way, the forces occurring on the connection between the base surface 15a and fascia 1 can in any case be reduced.
  • the edge 3 of the fixing element In order to enable a surface-engaging, force-locking and tissue-compatible connection between the base surface 15a and the fascia 1 , the edge 3 of the fixing element must sufficiently underlap or engage under the fascia 1 on all sides, consist of biocompatible or tissue-compatible material and have a suitable structure.
  • a biocompatible material is a textile material known under the trade name "Gore-tex", as is already used in vascular surgery.
  • Gore-tex a textile material known under the trade name "Gore-tex”
  • Such blood vessel prostheses can be sewn in tightly and withstand systolic blood pressure peaks up to more than 200 mmHg.
  • the edge 3 can be formed as shown in FIG. 3a .
  • a sufficiently rigid lower layer 7 distributes the pressure, which is generated by the seam or by a plurality of seams 10 , over a large area against the fascia 1 and at the same time offers a supporting layer for the fine tips or teeth 9 which grip flatly in the fascia 1 .
  • the tips or teeth 9 break through a soft sealing layer 8 , which is located above the lower layer 7 .
  • the seam 10 only grips the fascia 1 , but can also capture all layers of the abdominal wall 2 using suture techniques, such as with a bulge, and be supported on the skin 12 via a pressure-distributing disc 13 (FIG. 1 ). Furthermore, it is conceivable that a sewing or stapling device is used to create a tight seam on the fascia 1 .
  • the connection can also be supported and sealed with a fibrin glue. In this context, the use of silicone as an additional sealing material is also conceivable.
  • a plurality of drainage connections 14 are preferably integrated into the base surface 15a on one side of the fixing element 15 or can be retrofitted there, which have a screw thread, both for and after externally leading upper connecting piece 16 , as well as for the lower connecting piece 17 leading inwards.
  • the upper connecting pieces 16 are closed with screw plugs.
  • the drainage passages are incorporated in two reinforcement plates 18 , which enclose the base area 15a flat and pressure-tight from above and below. If one or more drainages are needed, they can be placed in the abdominal cavity with the tube 5 open and screwed onto the lower connector 17 . The extracorporeal drainage 28 can be screwed onto the upper connection piece 16 as a continuation even when the tube 5 is closed.
  • the tube 5 which is open at the top, rises. This is firmly and pressure-tightly connected to the base 15a and can close the central opening 4 and thus the abdominal cavity in a pressure-tight manner.
  • the tube 5 is closed by a rolling-in process via a rod 26 , for example divided into two.
  • Figure 5a shows that a rod-half 21 is occupied with pointed pins 31, that pierce the above two folded walls 22, 23 of the tube 5, wherein the collapsed Tubusrent 22, 23 can be folded before.
  • the second rod half 24 is pressed onto the pins 31 of the first rod half 21 via corresponding receptacles or holes 25 .
  • the merged tube 5 can be rolled over the rod 26 designed as a round rod and formed into a tube roller 19 .
  • the rolled tube 19 is now finally fixed with a cover flap 6 .
  • This cover flap 6 is firmly connected to the base surface 15a on the drainage connection 14 side. It reaches over the rolled-up tube 19 and stops on the opposite side.
  • An adhesive fastener such as a Velcro fastener 30 , is preferably used for this purpose.
  • the rod 26 can only be used as a rolling aid and can be pulled out after the rolling-in process.
  • the ends of the tube roller 19 can also be folded inwards and thus fixed by the overlapping cover flap 6 .
  • a kind of abdominal belt can be useful as an additional safeguard.
  • the tight closure between the fascia 1 and the base 33a of the fixing element 33 can be designed as a clamp closure 32 as follows.
  • the inner edge 34 of the fixing element 33 has to engage or underlap the fascia 1 sufficiently far on all sides, so that from the top on the inner edge 34 pressed clamping pieces 35 can clamp the fascia 1 sufficiently durable and tight.
  • the inner edge 34 of the clamp closure 32 preferably has a width of approximately 2 cm and is equipped with barbs 36 , which are preferably one to two cm long. Pressed against a clamping piece 35 attached from above, these barbs 36 pierce the fascia 1 from below and possibly also a part of the muscle layer adjoining upwards.
  • the clamping pieces 35 which are preferably constructed as a lattice block 40
  • the barbs 36 can snap into the individual openings of the lattice block 40 , depending on the pressure to different extents, in the corresponding horizontal layers or lattice planes 41 of the lattice block 40 .
  • Additional inner and outer seals 37 , 38 seal the clamp closure 32 in a liquid-tight manner.
  • lattice blocks 40 When using lattice blocks 40 as clamping pieces 35 , these consist of one or more lattice planes 41 which are provided with openings 42 for producing a fixed snap connection, which correspond to the prongs 39 of the barbs 36 .
  • sealing elements 37 , 38 which completely encompass the wound opening 4 are provided in the lower edge region 34 of the fixing element 33 between the latter and the fascia 1 on the one hand and between the fascia 1 and the clamping pieces 35 on the other hand.
  • the clamping pieces 35 can consist of elastically flexible solid material, for example of a rubber-elastic material or of rubber-elastic plastics, into which the barbs 36 can be pressed in order to produce a sufficiently force-fitting connection.
  • the release of the grating blocks 40 or generally the clamping pieces 35 from the inner edge of the base 33a of the fixing element 33 is expediently carried out using lever tools known per se.
  • the inner edge 34 of the base 33a of the fixing element 33 has a recess 43 which completely surrounds the wound opening 4 and which tapers in cross section on the surface in the direction of the fascia 1 , so that one or more clamping pieces 35 fit into it Recess 43 with the fascia 1 interposed, optionally in conjunction with other body tissue structures, can be locked as a sealing element.
  • the clamping pieces 35 preferably have a circular cross-section, so that they can be snapped into the likewise at least approximately circular recess 43 and are fixed in a non-positive and positive manner in this position due to the elastic design of the fixing element 33 .
  • This atraumatic clamp closure is characterized in that a preferably slightly flexible, cuttable rod, preferably a round rod, can be pressed into the recess 43 mentioned, and that this clamp connection ensures that the fascia 1 in between is not damaged.
  • markings for example in the form of numbers, letters, symbols or the like, on the base 15a or 33a of the fixing element 15 or 33 .
  • the entire wound closure, or at least those parts thereof, which come or can come into direct contact with the body tissue consist of a biocompatible material, such as, for example, the textile material known earlier under the trade name "Gore-tex" .
  • the tube 5 and the fixing element 15 are preferably formed in one piece, it is within the scope of a possible modification of the invention to design the tube 5 and the fixing element 15 as separate components and then to join them together to connect tightly.
  • the fixing element 15 consists of a single component. However, this does not rule out producing the fixing element 15 from a plurality of fixing element parts and connecting them tightly to one another.
  • Materials for the tube 5 are in particular flexible plastic films or textile plastics which can be provided on the surface with plastics or with other sealing and / or tissue-compatible materials.
  • adapter pieces for example, can be attached to the drainage connections 14 , through which laparoscopic examinations and / or interventions can be carried out.
  • the wound closure according to the invention opens up the possibility of different irrigation or irrigation / suction schemes.
  • Postoperative continuous open dorsoventral abdominal irrigation can also be easily achieved with the temporary abdominal wall closure according to the invention.
  • the cumbersome, disadvantageous palisade stabilization of the wound opening is eliminated.
  • the drainage connections 14 can be used as a rinsing inlet and a large-lumen drainage can be used as a suction pipe as a suction pipe and placed in the central tube opening 4 and sealed with the tube 5 , for example with a hose clamp or a quick connector.
  • a probe for measuring and ongoing control of the intraperitoneal pressure can be connected via a drainage connection 14 as permanent access.
  • clamp closure according to the invention enables faster implantation than the time-consuming sewing.
EP91918817A 1990-10-31 1991-10-31 Wundverschluss Expired - Lifetime EP0555293B1 (de)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE4034705 1990-10-31
DE4034705A DE4034705A1 (de) 1990-10-31 1990-10-31 Wundverschluss
PCT/DE1991/000849 WO1992007519A1 (de) 1990-10-31 1991-10-31 Wundverschluss

Publications (2)

Publication Number Publication Date
EP0555293A1 EP0555293A1 (de) 1993-08-18
EP0555293B1 true EP0555293B1 (de) 1994-09-21

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP91918817A Expired - Lifetime EP0555293B1 (de) 1990-10-31 1991-10-31 Wundverschluss

Country Status (15)

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US (1) US5437683A (es)
EP (1) EP0555293B1 (es)
JP (1) JP3249818B2 (es)
KR (1) KR0178412B1 (es)
AT (1) ATE111710T1 (es)
AU (1) AU651146B2 (es)
BR (1) BR9107037A (es)
CA (1) CA2095042C (es)
DE (3) DE4034705A1 (es)
DK (1) DK0555293T3 (es)
ES (1) ES2060408T3 (es)
FI (1) FI107228B (es)
NO (1) NO307074B1 (es)
RU (1) RU2089150C1 (es)
WO (1) WO1992007519A1 (es)

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US8585683B2 (en) 2006-06-02 2013-11-19 Kci Medical Resources Assemblies, systems, and methods for vacuum assisted internal drainage during wound healing
US8715267B2 (en) 2006-06-02 2014-05-06 Kci Medical Resources Assemblies, systems, and methods for vacuum assisted internal drainage during wound healing

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FI931895A (fi) 1993-04-27
NO931565D0 (no) 1993-04-29
DE9113283U1 (es) 1992-03-12
AU8748091A (en) 1992-05-26
DE59103065D1 (de) 1994-10-27
DK0555293T3 (da) 1994-11-14
NO307074B1 (no) 2000-02-07
NO931565L (no) 1993-04-29
ATE111710T1 (de) 1994-10-15
FI107228B (fi) 2001-06-29
KR930701945A (ko) 1993-09-08
ES2060408T3 (es) 1994-11-16
KR0178412B1 (ko) 1999-05-01
RU2089150C1 (ru) 1997-09-10
DE4034705A1 (de) 1992-05-07
AU651146B2 (en) 1994-07-14
US5437683A (en) 1995-08-01
JP3249818B2 (ja) 2002-01-21
EP0555293A1 (de) 1993-08-18
WO1992007519A1 (de) 1992-05-14
FI931895A0 (fi) 1993-04-27
CA2095042C (en) 2001-10-23
BR9107037A (pt) 1993-08-17
JPH06504212A (ja) 1994-05-19
CA2095042A1 (en) 1992-05-01

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